The Financial Impact of Juvenile Idiopathic Arthritis

While the costs of juvenile idiopathic arthritis (JIA) are sizable, the highest costs stemmed from medication and medical appointments, according to a study published in Pediatric Rheumatology.¹

“The treatment of JIA must be multilevel, with a pediatric rheumatologist, psychological support, physical therapy, nutrition, and family support. Within pharmacological treatment, a wide range of options with different costs and effectiveness could be found,” investigators explained. “With this perspective, considering the multiple medical appointments, laboratory tests, medications, and indirect costs, this disease generates elevated costs, which results in a high economic impact for the family.”

An experienced librarian conducted a systematic review of the databases MEDLINE, EMBASE, Web of Science, Scopus, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials to determine both direct and indirect costs in patients with JIA for at least 1 year. They included studies from January 2000 to July 2019, with an additional updated search in March 2021. Quality of the studies was assessed by a board of reviewers, comprised of 2 pediatric rheumatologists, 1 fellow in Pediatric Rheumatology, and 3 medical students. Eligible studies were ones that included either complete economic evaluations, partial economic evaluations, or individual studies that reported cost, such as clinical trials and observational studies.

DC included medical appointments, medications, hospitalizations, surgeries, alternative medicine, laboratory tests, clinical imaging, complications, travel expenses, insurance payments, and patient care. IC focused on loss of productivity via missed school or workdays, work impact on the patient or caregiver, early retirement of the patient or caregiver, and costs of caregiver productivity.

Costs were converted to United States dollars (USD).

Ultimately, of the 1334 studies obtained in the search, 18 studies with 6540 patients were analyzed. The most common were economic studies (n = 11), followed by cohorts (n = 4), and retrospective observational (n = 3). The countries of origin included Europe (n = 12), North American (n = 4), both Europe and North America (n = 1), and Asia (n = 1).

The TC, reported in 10 articles, ranged from $310 to $44,832 USD, with European countries reporting significantly higher costs compared with other regions. DC, available in 16 articles, ranged from $193 and $32,446 USD and was attributed to 55% to 98% percent of TC. Most DC was related to medications, hospitalizations, and medical appointments. IC, shown in 6 studies, ranged from $117 to $12,385 USD.

There was a correlation between polyarticular JIA and higher TC and DC, which increased costs up to 3-fold in those receiving biological therapy.

In an analysis of costs by country, TC varied between $4050 and $51,578 USD, with Bulgaria reporting the lowest costs and the United Kingdom reporting the highest costs. Of the 8 studies that reported both DC and TC, annual TC ranged from $1122 to $44,832 USD, with at least half of which relating to DC.

Interestingly, costs from JIA, ranging from $10,830 to $32,446 US, were higher than those reported in chronic arthritis in adults or patients with rheumatoid arthritis, ranging from $1862 to $20,262 USD.

Investigators utilized available evidence following a pre-designed protocol and performed an extensive search among different databases, which strengthened the study. Unfortunately, there is a high risk of reporting bias due to lack of consistency in economic aspects, different definitions, and data based on the perspective of external payers or health institutions. Additionally, a meta-analysis of costs was not performed, which would have aided in identifying areas of unmet support for patients with JIA and their families.

“This study synthesized the costs of JIA and highlights the financial risk that families could face during the disease trajectory,” investigators concluded. “It is necessary to standardize the reports and generate information from developing countries to obtain a more accurate analysis of the impact of the disease in the world.”

Reference:

García-Rodríguez F, Gamboa-Alonso A, Jiménez-Hernández S, et al. Economic impact of Juvenile Idiopathic Arthritis: a systematic review. Pediatr Rheumatol Online J. 2021;19(1):152. Published 2021 Oct 9. doi:10.1186/s12969-021-00641-y